Explaining Health Reform: Building Enrollment Systems That Meet The Expectations of the Affordable Care Act

The new health reform law will require most U.S. citizens and legal residents to have health coverage by 2014. It provides new options for coverage by expanding Medicaid eligibility to more low-income people and creating a state-based system of health insurance Exchanges through which individuals can purchase coverage, with federal subsidies for many.

The success of the law in achieving near-universal health coverage will depend on the effectiveness of the enrollment and renewal processes that states put in place. The law establishes the expectation that systems should enroll individuals with the minimum possible burden and handle transitions seamlessly.

This brief explains the key enrollment-related provisions of the health reform law, discusses the elements of an enrollment system that would comply with the law’s requirements and offers strategies — and examples — of how to achieve such a system.

With a quickly approaching 2014 deadline, states must begin working together with federal agencies and stakeholders to put critical policies and systems in place. As states address the immediate challenge of designing and building an Exchange, coordination with Medicaid and CHIP at all points in the enrollment process — from application at the front-end, to data retrieval and verification at the back end — is a fundamental organizing principle.